Imperial College Advanced Cancer Service
Imperial College Healthcare NHS TrustThe introduction of the Imperial College Advanced Cancer Service has pushed boundaries by being one of few centres to offer cytoreductive surgery (CRS) and heated intraoperative chemotherapy (HIPEC) to patients with colorectal peritoneal cancers. The team’s work has given patients across the country greater opportunities to be offered this pioneering and inventive treatment which, in turn, has led to better outcomes.
At the heart of the service are the roles played by Professor Jamie Murphy and Specialist Nurse Anne Moutadjer who were instrumental in setting up and developing the service. They both work alongside a team of consultants and the multidisciplinary team. Anne also plays a critical role in helping patients to understand and receive support through this arduous treatment pathway.
‘CRS and HIPEC is a major operation,’ explains Anne. ‘Even patients who have had previous cancer surgeries will find this one really tough, so we make sure they fully understand the process. When anyone is referred to us, we make sure we are there for them at every step. They are given my contact details and they can email me at any time and I will always reply – even at weekends – because I know that it’s important for patients to get answers straight away instead of being left in limbo.'
Metastatic Breast Oncology Team
Maidstone & Tunbridge Wells NHS Trust
People with secondary breast cancer have complex emotional and supportive needs. Research suggests that many feel their care is inadequate and there are significant gaps in the provision of information. The Metastatic Breast Oncology Team at the Kent Oncology Centre knew that their patients wanted to be empowered by information, but recognised that they often felt overwhelmed by it so they created a free, Kent-wide secondary breast cancer app, available for download on smartphones and tablets.
The Secondary Breast Cancer Patient Journey App, which was funded by local charity Breast Cancer Kent, puts a comprehensive range of trusted information at patients’ fingertips and signposts them to local and national services. It supports people to gain the knowledge, skills and confidence they need to effectively manage and make informed decisions about their own healthcare.
‘Patients told me they were overwhelmed by the piles of booklets that they were given when they were diagnosed,’ explains Consultant Oncologist Russell Burcombe. ‘They didn’t know how to navigate them and, all too often, they put them in a sideboard and never looked at them again. This app changes all that. We plan to continue to expand and develop because digital healthcare is here to stay.’
Urology Cancer Care Navigator
Jenny Chatfield, The Royal Wolverhampton NHS Trust
When Jenny Chatfield stepped into the newly created role of urology cancer care navigator in April 2020, the team perspective was for Jenny to support HNAs for all cancer patients and deliver personalised stratified follow-up care to men with prostate cancer. But, with the first national lockdown beginning and most of the nurses in her department being redeployed to assist with Covid patients, she had a reduced level of support in her role, plus she had to quickly get to grips with delivering support remotely.
Thanks to her self-motivation and commitment, Jenny didn’t let any of these challenges stop her from developing a vital service that delivers a level of holistic care that previously didn’t exist due to staff workloads. As well as becoming the confidant and friend that anxious, scared and worried patients turned to during the pandemic, Jenny’s interventions have also freed up time for consultants and clinical nurse specialists.
‘Patients needed additional support and input, but that didn’t necessarily need to be clinical input,’ explains Jenny. ‘Now I contact every newly diagnosed cancer patient to offer them an HNA. I also run the personalised stratified follow-up programme for prostate cancer patients, which helps support them to live well beyond and prior to their GP discharge.'
Thoracic Surgical Team
South Tees Hospitals NHS Foundation Trust
The need to support patients post-operatively following lung cancer surgery has always been critical, but during the pandemic this need increased exponentially. Thankfully, four specialist Macmillan nurses in the Thoracic Surgical Team at South Tees Hospitals NHS Foundation Trust have implemented a first-of-its-kind service that reduces both hospital readmission rates and the risk of catching Covid.
Not only does the team care for thoracic patients in hospital after their surgery, but they also travel to their homes to provide medical, emotional and psychological support. The nurses can answer questions about surgery, recovery and symptom management, oversee pain control, refer patients to therapists, treat wound issues and provide test results.
The team, which consists of Stacey Stockdale, Hayley McNaught, Leanne Connelly, and Rachel Calvert, are now keen to help other organisations and tumour groups to develop similar post-surgical services for their cancer patients.
‘Prior to this, patients had to wait for six weeks until they saw the surgeon for follow-up – they had no formal post-operative support until then,’ says Rachel. ‘Now, patients are reassured by the fact that they’re going to be seen in their homes by somebody that they’ve met in clinic before their operation, and on the ward after their operation. They know they aren’t going to be abandoned after they’ve left the hospital.’
AOAU Therapies Team
Velindre Cancer Centre
In a unique and pioneering project at the Velindre Cancer Centre, a team of therapists have been successfully integrated into the acute oncology assessment unit (AOAU) to provide vital support to cancer patients who need hospital assessment.
The Macmillan-funded dietitian, physiotherapist and occupational therapist work alongside medical staff to provide timely, holistic assessment and interventions, particularly to those with complex needs. Because the service allows patients to access the therapists earlier, it means hospital admissions and length of stay have been reduced while quality of life has been improved.'
'Having these interventions as soon as possible, and at the right time for the patient, is key,’ explains Macmillan Clinical Lead Occupational Therapist Cathryn Lewis. ‘It prevents admissions and keeps people at home, which is undoubtedly the place they want to be. That has a huge impact on their function because the longer a patient stays in hospital, the quicker they can decondition.'
Northern Trust Cancer and Palliative Wellbeing Team
Northern Health & Social Care Trust
In Northern Ireland’s Northern Trust, the Cancer Services Team and the Palliative Care Team sit in different divisions, despite supporting patients at different points of the same pathway.
Recognising the importance of a co-ordinated approach, the staff worked collaboratively to establish a range of award-winning wellbeing programmes to support patients at any stage of their journey. These included Look Good Feel Better, fatigue management workshops and health and wellbeing events.
When the pandemic forced all events to be cancelled, the integrated team responded swiftly by designing a range of high-quality virtual wellbeing resources. They collaborated with clinical teams and patient representatives to create Zoom webinars, virtual pamper sessions and virtual fatigue workshops. They also worked with a production company to create accessible educational videos that are available both online and on DVD.
‘During Covid, we knew that there was no other support out there for patients, so we just had to go for it, work together and make this virtual offer a success,’ says Macmillan Occupational Therapist and member of the Palliative Care Team, Alison Craig. ‘They got a real sense of community and felt like they had the support to cope with things.’
Acute Oncology Triage TeamAltnagelvin Hospital
When Covid limited entry into the North West Cancer Centre in Altnagelvin Hospital, the Acute Oncology and Triage Team had to act fast to ensure their clinically vulnerable acute oncology and haematology patients remained safe and supported. By collaborating with stakeholders across the hospital, the team rapidly created a new model of care that prevented potential Covid-positive patients being admitted onto a Covid-negative ward.
‘We applied an extensive Covid checklist alongside the UKONS (United Kingdom Oncology Nursing Society) assessment on the Triage Helpline to stratify patients into those who had Covid symptoms and those who didn’t,’ says Interim Lead Nurse and Macmillan Nursing Services Manager Celia Diver-Hall.
‘For patients without Covid symptoms, we could maintain the normal pathway and bring them straight to the oncology/haematology ward. However, we couldn’t admit patients with Covid symptoms because it would put other immunocompromised patients at risk, but we couldn’t send them to the Emergency Department because of the increased risk of Covid in this clinical area, so we created an alternative pathway. Working with the Acute Medical Unit, we identified two beds in single isolation rooms to use as an assessment area. We also designed a new route into the hospital specifically for these patients. It was no mean feat!’
Macmillan Information and Support Centre
St George's Hospital University Hospital Foundation Trust
At the beginning of 2020, the Macmillan Information and Support Centre at St George’s Hospital had ambitions to consolidate and increase the services they provided to cancer patients. Unfortunately, as a result of the Covid pandemic, the centre had to close its doors, dismiss its volunteers and suspend all of its health and wellbeing activities until further notice.
The team were determined to make sure none of their patients felt alone or unsupported, so they quickly mobilised to create a YouTube channel and develop other new media initiatives. This meant that cancer patients in the hospital and those shielding at home could still receive the holistic care they needed during the most challenging time of their lives.
‘We had worked so hard to build up such a strong service, so when Covid happened there was a real sense of loss,’ says the centre’s manager Estelle Le Galliot. ‘It felt like we had been ripped away from our patients.
‘At that point, YouTube was a trend and Joe Wicks was starting to do his daily workouts, so I thought maybe we should try to do something like that too. Our cancer patient representative group were all for it, so we got together and came up with a plan to develop our own YouTube channel. Working closely with patients to make sure that we were creating this service together was crucial.'
The Royal Berkshire Cancer CNS Team
Royal Berkshire NHS Foundation Trust
The Macmillan Clinical Nurse Specialist (CNS) Team at The Royal Berkshire NHS Foundation Trust worked tirelessly to adapt and innovate throughout the Covid pandemic so they could continue to provide a high level of personalised care for cancer patients.
When lockdown first began, there was a huge increase in phone calls to the team’s services from anxious patients and their families seeking support, so the CNSs set up telephone and virtual support clinics where they proactively called patients and completed eHNAs with them. This meant that they were able to pre-empt any issues and worries that patients were experiencing before they became too overwhelming.
Not only did the CNSs use their vast array of experience and skills to support patients, but they also supported members of ward staff who were working alongside them during redeployment to the Family Liaison service.
Charged with calling the relatives of Covid patients who were dying or had died, the CNSs were able to model their excellent communications skills for ward staff and support them using their psychological training which helped to build their resilience.
‘This team of women have really inspired me, the ward staff and even the senior management in our cancer centre,’ says Lead Clinical Nurse Specialist Lisa Moyles. ‘Their skills, experience and knowledge were their special power during the pandemic because they were able to maintain some form of normality for our patients during an extremely abnormal time.'
Macmillan Radiotherapy Specialist Nurse
Lisa Copeland, St James's University Hospital
The pandemic and its associated periods of lockdown – has led to a growth in the amount of radiotherapy patients who have mental health issues. Over the past year, the Radiotherapy Patient Support Team at Leeds Teaching Hospitals Trust has seen a 40% increase in referrals from this patient cohort.
This small, specialist team is dedicated to supporting cancer patients with psychological difficulties to get through their treatment. As the team’s caseload has increased, so too has the complexity of the issues they are dealing with. However, thanks to the expertise, compassion and co-leadership of Macmillan Radiotherapy Specialist Nurse Lisa Copeland, patients have continued to receive exceptional support while the other members of the team, all therapeutic radiographers, have been inspired and supported by her every step of the way.
One of the team’s more complex cases required an unprecedented level of collaboration between ten teams across the Trust, and Lisa took it upon herself to liaise with all of them. She made sure communication was clear, foresaw any issues, and constantly fine-tuned the patient’s care to make sure their holistic needs were met. Lisa's superb efforts have raised the profile of the Radiotherapy Patient Support Team and encouraged collaboration across the board in her Trust.
‘The thing that really inspires me is seeing the difference that we make,’ says Lisa. ‘When you equip patients with the skills to get through radiotherapy, it’s just wonderful. I wish I could bottle that feeling.'
Macmillan Living with and Beyond Cancer Team
Barking, Havering, and Redbridge University Hospitals NHS Trust
The Living with and Beyond Cancer Team at Barking, Havering and Redbridge University NHS Trust provide invaluable Macmillan drop-in information and support and a range of health and wellbeing services for cancer patients. Having always offered these services face to face, the team had to rapidly adapt their way of working during the Covid pandemic.
Knowing that patients were struggling due to shielding, isolation, and uncertainty around their treatment, the team developed a proactive telephone wellbeing support service designed to help meet emotional, physical and practical needs. Members of the team gave each patient a fortnightly check-in call. With 1,479 patients to contact, this was no small undertaking.
As the pandemic progressed and the service became a lifeline for so many, the team recognised that this wasn’t a short-term fix but a model that enabled delivery of personalised cancer care. They therefore placed a successful bid to Macmillan for a personalised care nurse and additional support worker, and it is now a sustainable service that incorporates a full end-of-treatment HNA.
‘During Covid, the first thing we asked patients was how they were feeling physically, and we made sure they understood the guidance around shielding,’ says Macmillan Living With and Beyond Cancer Lead Lucy Brooks. ‘Then we asked whether they had access to essential supplies and medicines before discussing how they were keeping themselves active at home and how they were coping emotionally. We could offer tips and advice, and deal with any issues or escalate them to the appropriate teams. It was real holistic support.’
For your patients
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It’s quick and easy to order free booklets to give to your patients, their families and carers. Topics include cancer types, treatment, and emotional support.